- Email: [email protected]
Investigating the Relationship between Crusade Bleeding Score and Bleeding in TAVR patients – The Prince Charles Hospital Registry
S162
Abstracts CSANZ 2012 Abstracts
Heart, Lung and Circulation 2012;21:S143–S316
100 50
Investigating the Relationship between Crusade Bleeding Score and Bleeding in TAVR patients – The Prince Charles Hospital Registry
0
A. Incani ∗ , T. Butler, K. Poon, M. Savage, C. Aroney, C. Raffel, D. Walters
0
20
40 Crusade Score Hb_change Fitted values
80
95% CI
http://dx.doi.org/10.1016/j.hlc.2012.05.403 393 Is Stent Length Still a Major Predictor of Outcomes in the DES Era? J. Chandrasekhar ∗ , K. Kalam, P. Marley, A. Farshid The Canberra Hospital, Australia Background: Longer stent length and smaller diameters are associated with higher incidences of stent thrombosis and TVR. We sought to compare the effect of length and diameter in BMS and DES on MACE (defined as all cause death, MI, ST, TVR, CVA) at our institution. Methods: Retrospective analysis of the PCI database at our centre for all lesion entries from 2006 to 2011. All variables and adverse events were analysed per lesion. Stents were arbitrarily classified as long for length >18 mm and small for diameters <3.0 mm. Results: 3897 lesions were divided into eight groups as tabulated. ACS was the majority indication for PCI (72.82%). Mean age was 64y with 24.12% females. Diabetics constituted 16% of BMS and 39% of DES groups overall (p < 0.0001). B2/C lesions comprised 60.25% of BMS and 69.66% of DES groups overall (p < 0.0001). Mean follow up was 301 days. MACE censored at 400 days was as per the table. n
MACE
BMS ≤18 ≥ 3 BMS > 8 ≥ 3 BMS ≤18 < 3 BMS >18 < 3
1507 480 512 167
n
MACE
DES ≤ 18 ≥ 3 DES > 18 ≥ 3 DES ≤18 < 3 DES >18 < 3
456 251 321 179
7.68% 8.76% 7.79% 5.59%
8.49% 7.50% 9.57% 18.56%
0
20
60
Figure 2.
40
Background: The Crusade Bleeding Score (CBS) is predictive of in hospital major bleeding in acute coronary syndrome (ACS) patients, however its utility in other syndromes is unknown. We sought to investigate the relationship between the CBS and bleeding in Trans Catheter Aortic Valve Replacement (TAVR) patients. Methods: A retrospective analysis of our TAVR registry was performed focusing on bleeding as defined by the VARC criteria. As part of this, preoperative and discharge haemoglobin (Hb) values were collected as well as the number of units of packed red blood cells (PRBC) transfused. Each patient had their CBS calculated. Simple change in Hb (SCHB) was defined as preoperative Hb minus discharge Hb. Absolute change in Hb (ACHB) was defined as SCHB + 10× number of PRBC units received during their admission. A pairwise correlation test was then performed to determine if a correlation existed between CBS and SCHB or ACHB. Results: 105 patients were included from 25/8/2008 to 20/9/2011. Mean Hb over the admission decreased from 121.2 ± 16.9 to 105 ± 13.7 g/dL (p < 0.0001). Mean CBS was 39.2 ± 12.1. Mean SCHB was 15.6 ± 13.7 and mean ACHB was 22.4 ± 13.7 g/dL. There was a counter-intuitive negative weak correlation between SCHB and CS (Fig. 1: correlation coefficient −0.25, p = 0.01) but no correlation between ACHB and CS (Fig. 2: correlation coefficient −0.03, p = 0.75). Conclusion: Unlike in ACS patients, the crusade bleeding score is not a useful clinical risk stratification tool for bleeding in TAVR patients.
-50
The Prince Charles Hospital, Australia
-20
ABSTRACTS
392
0
20
40 Crusade Score hbcharge(pre-dis) Fitted values
Figure 1.
60 95% CI
80
p = 0.0008; p = 0.66.
Conclusion: Use of long BMS < 3 mm in diameter was associated with the highest incidence of MACE. Long
Abstracts CSANZ 2012 Abstracts
Heart, Lung and Circulation 2012;21:S143–S316
100 50
Investigating the Relationship between Crusade Bleeding Score and Bleeding in TAVR patients – The Prince Charles Hospital Registry
0
A. Incani ∗ , T. Butler, K. Poon, M. Savage, C. Aroney, C. Raffel, D. Walters
0
20
40 Crusade Score Hb_change Fitted values
80
95% CI
http://dx.doi.org/10.1016/j.hlc.2012.05.403 393 Is Stent Length Still a Major Predictor of Outcomes in the DES Era? J. Chandrasekhar ∗ , K. Kalam, P. Marley, A. Farshid The Canberra Hospital, Australia Background: Longer stent length and smaller diameters are associated with higher incidences of stent thrombosis and TVR. We sought to compare the effect of length and diameter in BMS and DES on MACE (defined as all cause death, MI, ST, TVR, CVA) at our institution. Methods: Retrospective analysis of the PCI database at our centre for all lesion entries from 2006 to 2011. All variables and adverse events were analysed per lesion. Stents were arbitrarily classified as long for length >18 mm and small for diameters <3.0 mm. Results: 3897 lesions were divided into eight groups as tabulated. ACS was the majority indication for PCI (72.82%). Mean age was 64y with 24.12% females. Diabetics constituted 16% of BMS and 39% of DES groups overall (p < 0.0001). B2/C lesions comprised 60.25% of BMS and 69.66% of DES groups overall (p < 0.0001). Mean follow up was 301 days. MACE censored at 400 days was as per the table. n
MACE
BMS ≤18 ≥ 3 BMS > 8 ≥ 3 BMS ≤18 < 3 BMS >18 < 3
1507 480 512 167
n
MACE
DES ≤ 18 ≥ 3 DES > 18 ≥ 3 DES ≤18 < 3 DES >18 < 3
456 251 321 179
7.68% 8.76% 7.79% 5.59%
8.49% 7.50% 9.57% 18.56%
0
20
60
Figure 2.
40
Background: The Crusade Bleeding Score (CBS) is predictive of in hospital major bleeding in acute coronary syndrome (ACS) patients, however its utility in other syndromes is unknown. We sought to investigate the relationship between the CBS and bleeding in Trans Catheter Aortic Valve Replacement (TAVR) patients. Methods: A retrospective analysis of our TAVR registry was performed focusing on bleeding as defined by the VARC criteria. As part of this, preoperative and discharge haemoglobin (Hb) values were collected as well as the number of units of packed red blood cells (PRBC) transfused. Each patient had their CBS calculated. Simple change in Hb (SCHB) was defined as preoperative Hb minus discharge Hb. Absolute change in Hb (ACHB) was defined as SCHB + 10× number of PRBC units received during their admission. A pairwise correlation test was then performed to determine if a correlation existed between CBS and SCHB or ACHB. Results: 105 patients were included from 25/8/2008 to 20/9/2011. Mean Hb over the admission decreased from 121.2 ± 16.9 to 105 ± 13.7 g/dL (p < 0.0001). Mean CBS was 39.2 ± 12.1. Mean SCHB was 15.6 ± 13.7 and mean ACHB was 22.4 ± 13.7 g/dL. There was a counter-intuitive negative weak correlation between SCHB and CS (Fig. 1: correlation coefficient −0.25, p = 0.01) but no correlation between ACHB and CS (Fig. 2: correlation coefficient −0.03, p = 0.75). Conclusion: Unlike in ACS patients, the crusade bleeding score is not a useful clinical risk stratification tool for bleeding in TAVR patients.
-50
The Prince Charles Hospital, Australia
-20
ABSTRACTS
392
0
20
40 Crusade Score hbcharge(pre-dis) Fitted values
Figure 1.
60 95% CI
80
p = 0.0008; p = 0.66.
Conclusion: Use of long BMS < 3 mm in diameter was associated with the highest incidence of MACE. Long